Research Reveals Underreporting in Health Histories

Evidence continues to mount that oral health is a key component of overall health, but without access to patients’ medical records, dentists must rely on patients to accurately share their health histories. While the health history is an important part of treatment planning, a new study finds that for two of the most common conditions that may impact dental care — diabetes and hypertension — patients are unreliable relators of health information.¹

Nationally, 30.3 million Americans live with diabetes, which equates to nearly 10% of the U.S. population.² Hypertension is even more prevalent. Nationally, across both genders and ages 18 and over, it affects 29% of the U.S. population, with the incidence rate increasing with age.³ Both diseases can impact treatment planning and lead to complications, especially during extensive dental work. For example, patients with uncontrolled hemoglobin A1c levels could face challenges healing after oral surgery and may be prone to bacterial infection. Similarly, individuals with uncontrolled hypertension may be subject to an elevated bleeding risk and stroke.

To examine the reliability of patients self-reported health information, researchers compared electronic dental records with the subjects’ electronic medical records and found that more than 15% of patients with diabetes failed to report this accurately to their dentist. In addition, nearly a third of patients with hypertension failed to report high blood pressure.¹

Although the reasons are unclear, researchers theorize that patients may simply forget or not understand why it is important for their dentist to know about these conditions. Terminology could also be an issue. Patients did better reporting diabetes than hypertension, perhaps because some might not have equated the word hypertension with high blood pressure.

Since the ideal solution — the universal integration medical and dental records — may not be possible for some time, researchers advise dentists to approach patient self-reports with caution and question patients further, if needed. In addition, the team suggests using common terms, such as “high blood pressure” (in addition to medical terms), on health histories and in conversations with patients to avoid any misunderstandings.

REFERENCES

1. Adibi S, Li M, Salazar N, et al. Medical and dental electronic health record reporting discrepancies in integrated patient care. JDR Clin Trans Res. September 27, 2019. [Epub ahead of print]
2. National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation. National Diabetes Statistics Report, 2017: Estimates of Diabetes and its Burden in the United States. Available at: https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed October 18, 2019.
3. Fryar CD, Ostchega Y, Hales CM, Zhang G, Kruszon-Moran D. Hypertension Prevalence and Control Among Adults: United States, 2015–2016. NCHS data brief, No. 289. National Center for Health Statistics. 2017. Available at https://www.cdc.gov/nchs/data/databriefs/db289.pdf. Accessed October 18, 2019.

From Decisions in Dentistry. November/December 2019;5(10):54.